Provider Demographics
NPI:1417417312
Name:UPSHAW, TIAMEKA
Entity Type:Individual
Prefix:
First Name:TIAMEKA
Middle Name:
Last Name:UPSHAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TIAMEKA
Other - Middle Name:
Other - Last Name:UPSHAW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:244 JAMES CIRCLE
Mailing Address - Street 2:
Mailing Address - City:LAKE ALFRED
Mailing Address - State:11
Mailing Address - Zip Code:33850
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:244 JAMES CIRCLE
Practice Address - Street 2:
Practice Address - City:LAKE ALFRED
Practice Address - State:11
Practice Address - Zip Code:33850
Practice Address - Country:UM
Practice Address - Phone:863-547-5174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care